Legal ADA Document

LEGAL ADA ACCOMMODATION AGREEMENT

This ADA Accommodation Agreement (the Agreement) is entered into as of by and between Employer Name: and Individual Name: (together the Parties).

RECITALS

WHEREAS, Employee has disclosed a medical condition that may constitute a disability under applicable law and has requested reasonable accommodation(s) to perform the essential functions of the Employee's position; and

WHEREAS, Employer is committed to providing reasonable accommodations to qualified individuals with disabilities and to engaging in a timely, good faith interactive process to identify effective accommodations; and

WHEREAS, the Parties wish to document the scope, terms, and conditions of the agreed accommodation(s) and the obligations of each Party.

NOW, THEREFORE, in consideration of the mutual covenants contained herein, the Parties agree as follows:

1. DEFINITIONS

For purposes of this Agreement: (a) "Disability" means a physical or mental impairment that substantially limits one or more major life activities as demonstrated by documentation provided to Employer; (b) "Accommodation" means a reasonable modification or adjustment to a job, the work environment, or the way things are customarily done that enables a qualified individual with a disability to perform the essential functions of the position; and (c) "Interactive Process" means the collaborative, individualized dialogue between Employer and Employee to identify appropriate accommodations.

2. REQUEST FOR ACCOMMODATION

Employee has requested the following accommodation(s):

Accommodation category (check all that apply):

3. DOCUMENTATION AND CONFIDENTIALITY

Employee shall provide documentation supporting the need for accommodation as reasonably requested by Employer. Medical information and records provided in connection with this Agreement are protected health information and will be maintained separately from Employee's personnel file and treated as confidential to the extent required by law.

Describe documentation provided or expected:

4. INTERACTIVE PROCESS AND TIMELINE

The Parties agree to engage in the Interactive Process in good faith. Employer will acknowledge receipt of Employee's request within and will provide a determination or a written interim proposal within following receipt of reasonably complete documentation.

5. AGREED ACCOMMODATION(S) AND IMPLEMENTATION

The Parties agree that Employer shall implement the following accommodation(s) as required by this Agreement:

Implementation schedule and responsible party:

6. TEMPORARY OR PROVISIONAL ACCOMMODATIONS

If the agreed accommodation cannot be implemented immediately, Employer may provide temporary or provisional accommodations pending full implementation. Temporary accommodations shall not exceed unless mutually agreed in writing.

7. NON-RETALIATION

Employer affirms that it will not retaliate against Employee for requesting or using reasonable accommodations. Any adverse employment action purportedly taken for a reason related to this Agreement must be documented and communicated to Employee in writing with the explanation of the business justification.

8. REVIEW, MODIFICATION, AND TERMINATION

The Parties agree to review the effectiveness of the accommodation(s) within after implementation. Either Party may request modification of the accommodation(s) based on changed circumstances or new information. Employer reserves the right to modify or discontinue an accommodation if it can demonstrate that the accommodation is no longer effective or imposes an undue hardship, subject to reasonable notice and consultation.

9. REPRESENTATIONS AND CERTIFICATIONS

Employee hereby certifies that the information and documentation provided to Employer in support of the requested accommodation(s) are true and accurate to the best of Employee's knowledge. Employee acknowledges that knowingly providing false information may result in disciplinary action.

10. NOTICES

Any notice required or permitted under this Agreement shall be in writing and delivered to the contact designated below for each Party.

11. AMENDMENTS; WAIVER; COUNTERPARTS

This Agreement may be amended only by a written instrument executed by both Parties. Failure by either Party to enforce any provision of this Agreement shall not constitute a waiver of that provision or any other provision. This Agreement may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one instrument.

12. GOVERNING LAW; ENTIRE AGREEMENT; SEVERABILITY

This Agreement shall be governed by and construed in accordance with the laws of the state specified for disputes: without regard to choice-of-law principles. This Agreement constitutes the entire agreement between the Parties with respect to the subject matter hereof and supersedes all prior agreements and understandings, whether written or oral. If any provision of this Agreement is held invalid or unenforceable, the remaining provisions shall remain in full force and effect.

13. MISCELLANEOUS PROVISIONS

The Parties agree to cooperate in good faith to resolve disputes arising under this Agreement. Any dispute that cannot be resolved through the Interactive Process shall be escalated to the Employer's human resources representative and the Employee's designated representative for resolution.

Additional notes or special provisions:

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